#womensheart

“You throw like a girl” and “You need to man up” are two common phrases used that emphasize how society expects men and women to act. Such phrases perpetuate stereotypes that associate masculinity with positive traits (strength, courage, etc.) and associate femininity with negative traits (openness, fragility, etc.) (Samulowitz et al., 2018). Although strides have been taken to disassociate the positive and negative connotations of masculine and feminine values, gender norms serve to regulate male dominance in society (Samulowitz et al., 2018) and influence the quality of healthcare women receive.

As strength is associated with masculinity, women are often presumed to be weak and have low pain tolerances. The gendered bias towards women has led health professionals to believe women are overreacting when in pain and therefore devalue the severity of women’s complaints (Samulowitz et al., 2018). As a result, women experience a lower urgency in a hospital setting and are 20% less likely to be treated immediately for presumed heart attack than men (Mackay, 2020).

Through gender norms, the white male body has been socially classified as the “normal” body. Therefore, most standardized symptoms and treatments are based upon the male body. Consequently, these gender norms serve to disadvantage women as they are only viewed in comparison to men, leading to misdiagnosis. (Alcalde-Rubio et al., 2020). For example, the most common symptom associated with heart attacks is chest pain; however, women often present instead with jaw or neck pain. Due to different symptom presentations, women are half as likely to be referred to a cardiologist (Clerc Liaudat et al., 2018).

In conclusion, the differential treatment of men and women in the healthcare field is not a result of biological differences but a product of gender bias and norms for which the healthcare system was formed.

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What do you think of when someone says heart attack? What about heart palpitations, coronary heart disease or stroke? If you are like most of the population, odds are you did not think of women. However, cardiovascular disease (CVD) continues to be a leading cause of death among women in Canada, second only to cancer (Statistics Canada, 2021), and the single greatest cause of death for women in the United States (Bairey Merz et al., 2017). Despite this, most people are not aware of the implications of cardiovascular disease in women's health. For example, a study in the United States found that only 45% of women surveyed were aware of CVD being the number one killer for women (Bairey Merz et al., 2017). Obviously, there is a need for increased awareness surrounding women's health and cardiovascular disease. That’s where we come in! Women’s Vital is a blog aimed at advocating and raising awareness for women's health and its specific connection with cardiovascular disease! 

Let’s begin with some quick facts about CVD in women:

Women are less likely to report symptoms associated with heart attacks, coronary heart disease and other cardiovascular pathologies (Merz et al., 2017)

Physicians are less likely to screen women for potential cardiovascular abnormalities (Bairey Merz et al., 2017) 👩🏽‍⚕️

Cardiovascular research in women lags behind men! This leads to poorer understandings of the unique ways CVD can present in women and its causes (Bucciarelli-Ducci, 2020) 🤕

Women are, on average, 10 years older than their male counterparts when they suffer a cardiovascular event, such as a heart attack (Stramba-Badiale, 2006) 🚩

Women are more likely to experience shortness of breath, fatigue, indigestion or nausea, back or neck pain, and chest discomfort (but not sharp pain) related to heart disease (Heart and Stroke Foundation of Canada)! This is a different profile compared to men! 🙍🏼‍♀️

Before 1986, research in females that did not concern reproduction received little attention (Thomas & Braus, 1998). This decreased the amount of information available regarding women's health, and still contributes to the lack of awareness surrounding women's health and their risk for cardiovascular disease! Before research was done within women populations, CVD was largely regarded as more frequent in men (Thomas & Braus, 1998). However, recent knowledge has shown the opposite is true, and it is important to raise awareness surrounding the issue, with the potential to save lives! 

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Female involvement in sports and physical activity has long been undermined within research and health promotion in the past (Oguma & Shinoda-Tagawa, 2004). However, this lack of representation is unfortunate given the importance of physical activity and a healthy lifestyle for women's health. Surely, lifestyle factors (such as physical activity participation, minimal screen time, and avoidance of drugs, smoking, and alcohol) are incredibly influential for minimizing the already enhanced risk of cardiovascular disease (CVD) within women (compared to men). For example, Chomistek et al. (2015) outlined the reduction of all-cause mortality due to cardiovascular disease, along with the incidence of cardiovascular-related health issues, to be minimized when women maintained recommended levels of physical activity! This is excellent news for women given the many unmodifiable factors that are currently contributing to higher CVD rates within the population, such as menopause, early menstruation onset, and contraceptives, to name a few (check out our previous posts for more information about these topics!). 

Now you may be wondering, what are the recommended levels of physical activity?

Adults are advised to obtain at least 150 minutes of moderate to vigorous aerobic exercise per week, preferably in 10-minute bouts scattered throughout the week! 

Aerobic activity can include going for a walk, bike ride with friends or family, or having a dance break to your favourite song! Additionally, it is recommended that adults participate in muscle-strengthening activities (such as weight lifting) and avoid prolonged bouts of sitting (Canadian Society for Exercise Physiology, 2021) 

Oguma and Shinoda-Tagawa (2004) described the impact of physical activity on cardiovascular disease in women as a "dose-response," meaning that the more physical activity you do, the more significant the reduction in CVD risk. However, they also found that inactive women would benefit from even a little bit of exercise. For example, even as little as one hour of walking per week can reduce a woman's risk of developing overall CVD (including decreased risk for stroke and coronary heart disease (Oguma & Shinoda-Tagawa, 2004)!

Overall, physical activity is a great modifiable lifestyle factor that can significantly reduce women's risk of cardiovascular disease! It is important for women to participate in weekly (and possibly daily) physical activity to help reduce their risk of developing CVD, the leading cause of death for women. 

P.S. Let us know your favourite way to get active in the comments!

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Throughout pregnancy, the body goes through many necessary changes to support the developing baby. Although size may be the first and most visual, many other important changes cannot be seen, including adaptations to the cardiovascular system. Doctors have called pregnancy the "ultimate stress test" (Nelander et al., 2016) as changes during pregnancy can exacerbate pre-existing conditions or cause new ones, which unfortunately can present serious challenges for maternal health during pregnancy and in the future (Hall et al., 2011).

It is often misunderstood that women are no longer affected by maternal physiological adaptations once pregnancy is over. However, complications and conditions that develop during pregnancy and delivery can have major health effects that can emerge years or decades after giving birth.

Populations at Risk

Women who have a history of gestational diabetes have a 70% higher risk for developing CVD. The increased risk is related to later attaining Type 2 Diabetes, which is experienced by roughly half of all women who've had gestational diabetes within ten years. (Rich-Edwards et al., 2010; Shah et al., 2008)

Women who experience preeclampsia, a hypertensive disorder, during pregnancy are four times more likely to have hypertension in the future and twice as likely to develop heart disease than women who did not have preeclampsia. (Rich-Edwards et al., 2010; Nelander et al., 2016)

Mothers who deliver preterm (<37 weeks of gestation) are around twice as likely to develop CVD compared to mothers whose pregnancies lasted a full term. (Rich-Edwards et al., 2010; Gao et al., 2020)

In conclusion, cardiovascular conditions that develop during pregnancy have a significant influence on women's health in the future. We must focus on implementing interventions to support women's cardiovascular health during pregnancy to benefit mothers in the short and long term.

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It’s the big question… “What should I eat today to be healthy?” The basis of this question should be simple, but in reality, it just isn’t that easy. Understanding how to eat to stay healthy is a confusing topic that is only made more difficult by dieting culture. Despite its complex nature, food consumption is a vital component of women’s cardiovascular health (Chomistek et al., 2015). Therefore, it is crucial that every woman be given the knowledge to make the most appropriate food choices based on individual circumstances. The most recent evidence does not advocate for gender-specific dietary guidelines (Hoekstra et al., 2009). Consequently, current dietary guidelines for cardiovascular health are universal for men and women. 

Considerations for a heart-healthy diet:

Eat your fruits and vegetables. Although this might be intuitive, both fruit and vegetable consumption has been associated with a lower risk of cardiovascular disease (CVD) (He et al., 2007). Green leafy vegetables are also strongly encouraged, while fruit juices should be avoided.

Get your whole grains in! Try whole grain oatmeal or brown rice, as a higher consumption of whole grains is associated with a lower risk of CVD (Mellen et al., 2008).

Add in some Alternatives. Vegetable proteins such as tofu, nuts and legumes are a great source of protein and are associated with a lower risk of CVD (Bernstein et al., 2010). Fish is another excellent alternative for red meat. Fish species that are abundant in omega 3 fatty acids have protective effects from cardiac arrhythmias, sudden cardiac death, and CVD incidence (Mozaffarian & Rimm, 2006).

Sodium in moderation. A high sodium intake has been associated with higher blood pressure levels which have been shown to increase the risk for stroke and CVD (Strazullo et al., 2009).

Remember that eating a heart-healthy meal does not mean you have to stop eating what you love. Work with your desires instead of against them! Try to have fun with your food choices to make you feel good in the moment and for the future!

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Given the monthly occurrence of menstruation for women, it may be hard to believe that it is still a taboo subject in so many cultures around the world. However, menstruation is still largely tied to stigma where women are forced to physically and socially conceal their menstruation from others. Johnston-Robledo and Chrisler (2013) regard media to have a particularly active role in the reproduction (pun intended) of this stigma. For example, media often promote concealment of menstruation as a selling point for their products. This is an unfortunate trend given the effects menstruation can have on the health of the female body and her risk to cardiovascular disorder (CVD)! Let's take a closer look at the link between menstruation and cardiovascular disease:

Post-menopausal women have a higher risk of developing cardiovascular disease than women who have not gone through menopause (Gross-Sawicka & Gorodeski, 2020)!

Early onset of menstruation (scientifically, known as menarche), referred to period onset before 10 years old, leads to increased risk of heart attacks, stroke, heart failure, and all cause mortality from CVD (Gross-Sawicka & Gorodeski, 2020)!

Studies have found that the higher risk of CVD due to early onset of menstruation is highest between the ages of 25 and 44 years old (Zheng et al., 2020)! Additionally, those who had later onset of menstruation displayed better cardiovascular health than those who had begun menstruating before the age of 10 (Zheng et al., 2020)!

The pattern of age within the increased risk of CVD and early menarche has been thought to be due to hormonal factors later in life, such as reduced estrogen (Zheng et al., 2020; Gross-Sawicka & Gorodeski, 2020).

Overall, women with an early onset of menarche (<10 years old) and those who have undergone menopause are both at a higher risk of cardiovascular diseases (such as heart attacks, strokes, and heart failure). Unfortunately, these factors can be hard to control and may even be difficult to discuss due to the stigma surrounding menstruation. However, together we can break the stigma and provide a better future for women's health and its dialogue! Keep an eye out for our next post to get involved in breaking the stigma around menstruation!

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